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Akhavan AA, Pang JH, Morrison SD, Satterwhite T. Gender Affirming Facial Surgery-Anatomy and Procedures for Facial Masculinization. Oral Maxillofac Surg Clin North Am 2024; 36:221-236. [PMID: 38458858 DOI: 10.1016/j.coms.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
For some patients, feminine facial features may cause significant gender dysphoria. Multiple nonsurgical and surgical techniques exist to masculinize facial features. Nonsurgical techniques include testosterone supplementation and dermal fillers. Surgical techniques include soft tissue manipulation, synthetic implants, regenerative scaffolding, or bony reconstruction. Many techniques are derived from experience with cisgender patients, but are adapted with special considerations to differing anatomy between cisgender and transgender men and women. Currently, facial masculinization is less commonly sought than feminization, but demand is likely to increase as techniques are refined and made available.
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Affiliation(s)
- Arya Andre Akhavan
- Division of Plastic and Reconstructive Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Suite E1620, Newark, NJ 07103, USA; Align Surgical Associates, 2299 Post Street, Suite 207, San Francisco, CA 94115, USA
| | - John Henry Pang
- Align Surgical Associates, 2299 Post Street, Suite 207, San Francisco, CA 94115, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356165, Seattle, WA 98195, USA
| | - Thomas Satterwhite
- Align Surgical Associates, 2299 Post Street, Suite 207, San Francisco, CA 94115, USA; Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center.
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Sabri H, Tehranchi A, Sarkarat F. 3-dimensional analysis of nasal soft tissue alterations following maxillary Lefort I advancement with and without impaction using 3D photogrammetry scanner. Oral Maxillofac Surg 2024; 28:111-123. [PMID: 36322249 PMCID: PMC9628311 DOI: 10.1007/s10006-022-01121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE This study was designed to investigate the changes in nasal soft tissue following maxillary Lefort I advancement with and without impaction in subjects presenting a skeletal class III malocclusion, using a 3D photogrammetry scanner. MATERIALS AND METHODS Patients with class III malocclusion undergoing Lefort I advancement with and without impaction and bilateral sagittal split osteotomy with the standard technique were included in this study. Patients were divided into two groups: maxillary Lefort I advancement alone (group 1) and combined with impaction (group 2). Facial soft tissue landmarks of the nose including nasal height (NH), nasal length (NL), nasal tip projection (NTP), alar width (AW), alar base width (ABW), subalar width (Sbal), nasolabial angle (NLA), nasofrontal angle (NFA), and columella inclination (CI) before and at least 4 months after surgery were obtained by a 3D scanner. RESULTS Twenty-one patients were included in this study (Group 1: 11 and Group 2: 10). NH, NTP, and NL decreased significantly in both groups following surgery. In addition, Sbal decreased only in group 2. On the other hand, NLA and CI increased significantly in group 2. The inter-group comparison revealed a statistically significant difference in the alterations in NH, NL, and CI between the two groups. CONCLUSION Changes in the nose soft tissue occurred after both surgeries, but their type and extent were different. Actions taken to reduce unwanted changes need to be further investigated. To evaluate the changes, 3D photogrammetry scan is a feasible imaging technique that can be used, providing numerous benefits.
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Affiliation(s)
- Hamoun Sabri
- Dental Research Center, School of Dentistry, Shahid Beheshti University of Medical Sciences, SBUMS, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113 Iran
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI USA
| | - Azita Tehranchi
- Dental Research Center, Dental Research Institute, Department of Orthodontics, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzin Sarkarat
- Department of Oral and Maxillofacial Surgery, Cranio-Maxillofacial Research Center, Dentistry Branch of Islamic, Azad University of Medical Sciences, Tehran, Iran
- Department of Oral and Maxillofacial Surgery, Gulf Medical University, Sharjah, UAE
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Wang XW, Yang HF, Wang EB, Cui XY, Zhao YJ, Jiang JH. Slim the face or not: 3D change of facial soft and hard tissues after third molars extraction: a pilot study. BMC Oral Health 2023; 23:508. [PMID: 37479973 PMCID: PMC10362706 DOI: 10.1186/s12903-023-03214-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Whether slim the face or not after removed third molars is the concern of some orthodontic treatment candidates. The aim of this article is to explore the volume changes of facial soft and hard tissues after third molars extraction, as well as develop a reproducible clinical protocol to precisely assess facial soft tissue volume change. METHODS A non-randomized, non-blind, self-controlled pilot study was conducted. 24 adults aged 18-30 had ipsilateral third molars extracted. The body weight change was controlled within 2 kg. Structured light scans were taken under a standardized procedure pre-extraction (T0), three (T1), and six (T2) months post-extraction; CBCTs were taken at T0 and T2. The projection method was proposed to measure the soft tissue volume (STV) and the soft tissue volume change (STVC) by the Geomagic software. The hard tissue volume change (HTVC) was measured in the Dragonfly software. RESULTS The final sample size is 23, including 5 males (age 26.6 ± 2.5 years) and 18 females (age 27.3 ± 2.5 years). The HTVC was - 2.33 ± 0.46ml on the extraction side. On the extraction side, the STV decreased by 1.396 (95% CI: 0.323-2.470) ml (P < 0.05) at T1, and increased by 1.753 (95% CI: -0.01-3.507) ml (P = 0.05) at T2. T2 and T0 had no difference (P > 0.05). The inter and intra-raters ICC of the projection method was 0.959 and 0.974. There was no correlation between the STVC and HTVC (P > 0.05). CONCLUSIONS After ipsilateral wisdom teeth extraction, the volume of hard tissue on the extraction side reduces, and the volume of facial soft tissue does not change evidently. However, further research with large sample size is still needed. The STV measurement has excellent repeatability. It can be extended to other interested areas, including forehead, nose, paranasal, upper lip, lower lip and chin, which is meaningful in the field of orthodontics and orthopedics. TRIAL REGISTRATION ChiCTR, ChiCTR1800018305 (11/09/2018), http://www.chictr.org.cn/showproj.aspx?proj=28868 .
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Affiliation(s)
- Xin-Wen Wang
- Third Clinical Division, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, CN, China
| | - Hui-Fang Yang
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, CN, China
| | - En-Bo Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, CN, China
| | - Xin-Yu Cui
- Department of Orthodontics, Peking University School and Hospital of Stomatology, #22 Zhongguancun South Avenue, Haidian District, Beijing, CN, 100081, China
| | - Yi-Jiao Zhao
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, CN, China
| | - Jiu-Hui Jiang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, #22 Zhongguancun South Avenue, Haidian District, Beijing, CN, 100081, China.
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Development of novel artificial intelligence systems to predict facial morphology after orthognathic surgery and orthodontic treatment in Japanese patients. Sci Rep 2021; 11:15853. [PMID: 34349151 PMCID: PMC8339122 DOI: 10.1038/s41598-021-95002-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/13/2021] [Indexed: 12/15/2022] Open
Abstract
From a socio-psychological standpoint, improving the morphology of the facial soft-tissues is regarded as an important therapeutic goal in modern orthodontic treatment. Currently, many of the algorithms used in commercially available software programs that are said to provide the function of performing profile prediction are based on the false assumption that the amount of movement of hard-tissue and soft-tissue has a proportional relationship. The specification of the proportionality constant value depends on the operator, and there is little evidence to support the validity of the prediction result. Thus, the present study attempted to develop artificial intelligence (AI) systems that predict the three-dimensional (3-D) facial morphology after orthognathic surgery and orthodontic treatment based on the results of previous treatment. This was a retrospective study in a secondary adult care setting. A total of 137 patients who underwent orthognathic surgery (n = 72) and orthodontic treatment with four premolar extraction (n = 65) were enrolled. Lateral cephalograms and 3-D facial images were obtained before and after treatment. We have developed two AI systems to predict facial morphology after orthognathic surgery (System S) and orthodontic treatment (System E) using landmark-based geometric morphometric methods together with deep learning methods; where cephalometric changes during treatment and the coordinate values of the faces before treatment were employed as predictive variables. Eleven-fold cross-validation showed that the average system errors were 0.94 mm and 0.69 mm for systems S and E, respectively. The total success rates, when success was defined by a system error of < 1 mm, were 54% and 98% for systems S and E, respectively. The total success rates when success was defined by a system error of < 2 mm were both 100%. AI systems to predict facial morphology after treatment were therefore confirmed to be clinically acceptable.
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Almuzian M, Rowley J, Mohammed H, Wertheimer MB, Ulhaq A, Mheissen S. Three-dimensional nasolabial changes after maxillary advancement osteotomy in class III individuals: a systematic review and meta-analysis. Evid Based Dent 2021:10.1038/s41432-021-0188-9. [PMID: 34363031 DOI: 10.1038/s41432-021-0188-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Class III malocclusions with maxillary retrognathia are commonly treated with single jaw Le Fort I maxillary advancement. The three-dimensional (3D) effects of surgery on the nasolabial region varies among the clinical studies. Quantifying these changes is of great importance for surgical planning and obtaining valid consent. Objectives To investigate the 3D relationship between soft tissue and skeletal changes secondary to Le Fort I maxillary advancement surgery in skeletal class III patients.Search methods Comprehensive search of multiple electronic databases supplemented by a manual and grey literature search were undertaken from inception to 9 June 2020.Selection criteria Studies that evaluated the 3D soft tissue changes of patients before and after maxillary advancement surgery alone.Data collection and analysis Study selection, data extraction and risk of bias assessment were performed independently by two reviewers, with disputes resolved by a third reviewer. A quantitative synthesis of the data was pre-planned for pooling similar outcome measures.Results Four studies were included in the final review and meta-analysis, with a total of 105 patients (mean age 16.7 + 33.9 years). The mean maxillary advancement of the included studies was 5.58 mm (95% CI 5.20-5.96). The sagittal effects of surgery on nose tip projection and prominence were insignificant (P >0.05, two studies); however, subnasal projection (MD 1.7 mm, two studies) and upper lip projection (MD 2.90 mm, four studies) increased significantly in a forward direction after surgery (P <0.05). Le Fort I osteotomy widens the upper philtrum width (MD 0.84 mm, two studies) (P <0.05). Inconsistencies among the included studies were identified; therefore, the results should be interpreted with caution.Conclusions There is weak evidence based on quantitative assessments that Le Fort I maxillary advancement significantly affects the nasolabial soft tissue envelope mainly in a sagittal dimension. These changes are concentrated around the central zone of the nasolabial region. Future prospective studies on maxillary advancement osteotomy with a standardised method of assessment, taking into consideration the confounding factors, are required.
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Affiliation(s)
- Mohammed Almuzian
- DClinDent (Orthodontics), Research Fellow, University of Edinburgh, Edinburgh, UK
| | - Josh Rowley
- DClinDent (Orthodontics), Specialist Orthodontist in Private Practice, Edinburgh, UK
| | - Hisham Mohammed
- MSc (Orthodontics), Research Fellow, University of Edinburgh, Edinburgh, UK
| | - Mark B Wertheimer
- MDent (Orthodontics), Specialist Orthodontist in Private Practice, Johannesburg, South Africa
| | - Aman Ulhaq
- MSc (Orthodontics), Consultant Orthodontist, University of Edinburgh, Edinburgh, UK
| | - Samer Mheissen
- DDS, Syrian Board in Orthodontics, Former Instructor in Orthodontic Department, Syrian Ministry of Health Private Practice, Damascus, Syrian Arab Republic.
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Ho CT, Lai HC, Lin HH, Lo LJ, Denadai R. Cheek soft tissue prediction in cleft orthognathic surgery: A 3D computer-assisted investigation with comparative analysis. J Plast Reconstr Aesthet Surg 2021; 74:2683-2693. [PMID: 33906812 DOI: 10.1016/j.bjps.2021.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Le Fort I maxillary advancement and rotational movement have been adopted to treat patients with cleft-related skeletal Class III pattern and anteromedial cheek soft tissue deficiency, but cleft-specific cheek soft tissue prediction data are insufficient. This 3D imaging-based study addressed the issue. METHODS 3D craniofacial soft tissue and bone models were created from 32 consecutive patients who received computer-aided two-jaw orthognathic surgery for the correction of cleft-related Class III deformity and cheek soft tissue deficiency. Using superimposed 3D models, the cheek volumetric change, the cheek sagittal movement, and the 3D cheek mass position were calculated. 3D data from orthognathic surgery-treated patients with no cleft (noncleft cohort) and individuals with no facial deformity (3D norm value) were retrieved for comparative analysis. RESULTS Surgical maxillary advancement (p < 0.001) but not maxillary clockwise rotation (p > 0.05) had a significant impact on the cheek soft tissue change, with prediction models showing that maxillary advancement elucidated 77 and 79% of this change on the cleft and noncleft sides, respectively. Cleft cohort (0.46±0.12) had a significantly (p < 0.001) smaller cheek soft-to-hard tissue ratio than that of the noncleft cohort (0.73±0.13). Cleft maxillary advancements >4 mm resulted in a 3D cheek mass position (2.1±1.1 mm) similar (p > 0.05) to the 3D norm value (2.2±1.2 mm), but different (p = 0.037) from the noncleft cohort (2.38±0.7 mm). CONCLUSION This study showed that maxillary advancement but not the maxillary rotation affects the cheek soft tissue change, and the predictive values and comparative data could assist the orthodontist-surgeon interaction during preoperative planning and patient counseling.
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Affiliation(s)
- Cheng-Ting Ho
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Chih Lai
- Division of Craniofacial Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Rafael Denadai
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Three-Dimensional Evaluation of Soft Tissue Malar Modifications after Zygomatic Valgization Osteotomy via Geometrical Descriptors. J Pers Med 2021; 11:jpm11030205. [PMID: 33805736 PMCID: PMC7998522 DOI: 10.3390/jpm11030205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
Patients with severe facial deformities present serious dysfunctionalities along with an unsatisfactory aesthetic facial appearance. Several methods have been proposed to specifically plan the interventions on the patient's needs, but none of these seem to achieve a sufficient level of accuracy in predicting the resulting facial appearance. In this context, a deep knowledge of what occurs in the face after bony movements in specific surgeries would give the possibility to develop more reliable systems. This study aims to propose a novel 3D approach for the evaluation of soft tissue zygomatic modifications after zygomatic osteotomy; geometrical descriptors usually involved in face analysis tasks, i.e., face recognition and facial expression recognition, are here applied to soft tissue malar region to detect changes in surface shape. As ground truth for zygomatic changes, a zygomatic openness angular measure is adopted. The results show a high sensibility of geometrical descriptors in detecting shape modification of the facial surface, outperforming the results obtained from the angular evaluation.
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Gerbino G, Autorino U, Borbon C, Marcolin F, Olivetti E, Vezzetti E, Zavattero E. Malar augmentation with zygomatic osteotomy in orthognatic surgery: Bone and soft tissue changes threedimensional evaluation. J Craniomaxillofac Surg 2021; 49:223-230. [PMID: 33509673 DOI: 10.1016/j.jcms.2021.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/28/2020] [Accepted: 01/12/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of this prospective study is to objectively assess 3D soft tissue and bone changes of the malar region by using the malar valgization osteotomy in concomitant association with orthognatic surgery. MATERIALS AND METHODS From January 2015 to January 2018, 10 patients who underwent single stage bilateral malar valgization osteotomy in conjunction with maxillo-mandibular orthognatic procedures for aesthetic and functional correction were evaluated. Clinical and surgical reports were collected and patient satisfaction was evaluated with a VAS score. For each patient, maxillofacial CT-scans were collected 1 month preoperatively (T0) and 6 months after the operation (T1). DICOM data were imported and elaborated in the software MatLab, which creates a 3D soft tissue model of the face. 3D Bone changes were assessed importing DICOM data into iPlan (BrainLAB 3.0) software and the superimposition process was achieved using autofusion. Descriptive statistical analyses were obtained for soft tissue and bone changes. RESULTS Considering bone assessment the comparison by superimposition between T0 and T1 showed an increase of the distance between bilateral malar prominence (Pr - Pl) and a slight forward movement (87,65 ± 1,55 to 97,60 ± 5,91); p-value 0.007. All of the patients had improvement of α angle, ranging from 36,30 ± 1,70 to 38,45 ± 0,55, p-value 0,04 (αr) and 36,75 ± 1,58 to 38,45 ± 0,35; p-value 0,04 (αl). The distance S increased from 78,05 ± 2,48 to 84,2 ± 1,20; p-value 0,04 (Sr) and 78,65 ± 2,16 to 82,60 ± 0,90 (Sl); p-value 0,03. Considering the soft tissue, the comparison by superimposition between T0 and T1 showed an antero-lateral movement (p-value 0.008 NVL; p-value 0.001 NVR) of the malar bone projection together with an increase in width measurements (p-value 0,05 VL; p-value 0,01 VR). Angular measurement confirmed the pattern of the bony changes (p-value 0.034 αL; p-value 0,05 αR). CONCLUSION The malar valgization osteotomy in conjunction with orthognatic surgery is effective in improving zygomatic projection contributing to a balanced facial correction in midface hypoplasia.3D geometrical based volume and surface analysis demonstrate an increase in transversal and forward direction. The osteotomy can be safely performed in conjunction with orthognatic procedures.
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Affiliation(s)
- Giovanni Gerbino
- Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Italy
| | - Umberto Autorino
- Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Italy
| | - Claudia Borbon
- Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Italy.
| | - Federica Marcolin
- Department of Management and Production Engineering Politecnico of Torino, Italy
| | - Elena Olivetti
- Department of Management and Production Engineering Politecnico of Torino, Italy
| | - Enrico Vezzetti
- Department of Management and Production Engineering Politecnico of Torino, Italy
| | - Emanuele Zavattero
- Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Italy
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Chihara LL, Segantin JDF, Faria PEP, Sant'Ana E, Dias-Ribeiro E, Nogueira RLM, Ferreira-Júnior O. The Prediction Capacity 3-D Software, on a 2-D Analysis, in Planning the Positioning of the Upper Lip After Maxillary Advancement. Craniomaxillofac Trauma Reconstr 2020; 13:93-98. [PMID: 32642038 DOI: 10.1177/1943387520906670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose The maxillary advancement using Le Fort I osteotomy directly affects in the positioning of the upper lip (UL) and the nasolabial angle (NLA), which plays an important role in facial expression and aesthetics, because of this, the aim of this study was to evaluate the ability of Dolphin Imaging 11.8 software in predicting changes to the UL position and NLA in patients undergoing maxillary advancement. Materials and Methods It was a retrospective cohort study. Predictive and final tracings using pre- and postoperative Cone beam computed tomography (CBCT) of 24 patients undergoing maxillary advancement, regardless of mandibular movement, were compared. Whether the amount of advancement changes this predictability was also analyzed. The predictive and the 12-month postoperative data were evaluated using Dolphin Imaging 11.8 software and compared. Student t test was used to get the results. Results The vertical analysis of the incisal tip and cementoenamel junction of the upper central incisor (UCI) and of the UL were statistically significant (P = .001 for all). The horizontal measurements of the same variables (P = .238, P = .516, P = .930, respectively) and the NLA (P = .060) showed no statistical significance. The amount of advancement did not interfere with the variables analyzed, except for the exposure (P = .009) and inclination of the UCI (P = .010). Conclusion It was concluded that the amount of maxillary advancement does not interfere with the UL prediction; the prediction capacity of the software was good for the horizontal measurements, but had a significant error index for vertical measurements.
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Affiliation(s)
- Letícia Liana Chihara
- Department of Oral and Maxillofacial Surgery, Bauru School of Dentistry, University of São Paulo (USP), Bauru, São Paulo, Brazil
| | - Jéssica de Fátima Segantin
- Department of Oral and Maxillofacial Surgery, Bauru School of Dentistry, University of São Paulo (USP), Bauru, São Paulo, Brazil
| | - Paulo Esteves Pinto Faria
- Department of Oral and Maxillofacial Surgery, University of Ribeirão Preto (UNAERP), Ribeirão Preto, São Paulo, Brazil
| | - Eduardo Sant'Ana
- Department of Oral and Maxillofacial Surgery, Bauru School of Dentistry, University of São Paulo (USP), Bauru, São Paulo, Brazil
| | - Eduardo Dias-Ribeiro
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Campina Grande (UFCG), Patos, Paraíba, Brazil
| | - Renato Luiz Maia Nogueira
- Department of Oral and Maxillofacial Surgery, School of Pharmacy, Dentistry and Nursing, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | - Osny Ferreira-Júnior
- Department of Oral and Maxillofacial Surgery, Bauru School of Dentistry, University of São Paulo (USP), Bauru, São Paulo, Brazil
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Woo HK, Ajmera DH, Singh P, Li KY, Bornstein MM, Tse KL, Yang Y, Gu M. Evaluation of the relationship between malar projection and lower facial convexity in terms of perceived attractiveness in 3-dimensional reconstructed images. Head Face Med 2020; 16:8. [PMID: 32345357 PMCID: PMC7187519 DOI: 10.1186/s13005-020-00223-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/16/2020] [Indexed: 12/05/2022] Open
Abstract
Background This study aimed to investigate dental student’s perception of facial attractiveness with regard to different combinations of anteroposterior malar-jaw positions using 3-dimensional (3-D) reconstructed images of subjects. Methods Two Chinese young adults (1 male and 1 female) with straight profiles and average malar projections were selected for the study. 3-D facial images and cone-beam computed tomography images of these two subjects were superimposed using 3-D imaging software. Lateral and oblique views of nine different images were created by moving the maxillomandibular complex and/or zygomatic bone by 4 mm either forward or backward along the sagittal plane. One hundred three undergraduate dental students (n = 24, 33, and 46 students from the Year 3, 4, and 5, respectively) then scored lateral and 45° oblique view images of the newly reconstructed faces. Results In the present study, images with a neutral malar and retruded jaws were found to be the most attractive in both male and female subjects. In addition, the Protruded malar (PM) group (p < 0.001), and the Retruded Jaws (RJ) group were rated more attractive (p < 0.001). Furthermore, the Relatively Prominent malar (RP) group was rated more attractive (p < 0.001) when malar-jaw relative positions were compared. Conclusion This study shows that a neutral or a protruded malar favours facial attractiveness in both Chinese male and female subjects. Therefore, an appropriate relationship between malar projection and lower facial convexity should be taken into consideration while designing the orthodontic/orthognathic treatment plans for enhanced aesthetic outcomes.
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Affiliation(s)
- Hon Kwan Woo
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | | | - Pradeep Singh
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Kar Yan Li
- Central Research Laboratories, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Michael Marc Bornstein
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Kwan Lok Tse
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Yanqi Yang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Min Gu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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Lai HC, Denadai R, Ho CT, Lin HH, Lo LJ. Effect of Le Fort I Maxillary Advancement and Clockwise Rotation on the Anteromedial Cheek Soft Tissue Change in Patients with Skeletal Class III Pattern and Midface Deficiency: A 3D Imaging-Based Prediction Study. J Clin Med 2020; 9:E262. [PMID: 31963689 PMCID: PMC7020021 DOI: 10.3390/jcm9010262] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/09/2020] [Accepted: 01/16/2020] [Indexed: 02/05/2023] Open
Abstract
Patients with a skeletal Class III deformity may present with a concave contour of the anteromedial cheek region. Le Fort I maxillary advancement and rotational movements correct the problem but information on the impact on the anteromedial cheek soft tissue change has been insufficient to date. This three-dimensional (3D) imaging-assisted study assessed the effect of surgical maxillary advancement and clockwise rotational movements on the anteromedial cheek soft tissue change. Two-week preoperative and 6-month postoperative cone-beam computed tomography scans were obtained from 48 consecutive patients who received 3D-guided two-jaw orthognathic surgery for the correction of Class III malocclusion associated with a midface deficiency and concave facial profile. Postoperative 3D facial bone and soft tissue models were superimposed on the corresponding preoperative models. The region of interest at the anteromedial cheek area was defined. The 3D cheek volumetric change (mm3; postoperative minus preoperative models) and the preoperative surface area (mm2) were computed to estimate the average sagittal movement (mm). The 3D cheek mass position from orthognathic surgery-treated patients was compared with published 3D normative data. Surgical maxillary advancement (all p < 0.001) and maxillary rotation (all p < 0.006) had a significant effect on the 3D anteromedial cheek soft tissue change. In total, 78.9%, 78.8%, and 78.8% of the variation in the cheek soft tissue sagittal movement was explained by the variation in the maxillary advancement and rotation movements for the right, left, and total cheek regions, respectively. The multiple linear regression models defined ratio values (relationship) between the 3D cheek soft tissue sagittal movement and maxillary bone advancement and rotational movements of 0.627 and 0.070, respectively. Maxillary advancements of 3-4 mm and >4 mm resulted in a 3D cheek mass position (1.91 ± 0.53 mm and 2.36 ± 0.72 mm, respectively) similar (all p > 0.05) to the 3D norm value (2.15 ± 1.2 mm). This study showed that both Le Fort I maxillary advancement and rotational movements affect the anteromedial cheek soft tissue change, with the maxillary advancement movement presenting a larger effect on the cheek soft tissue movement than the maxillary rotational movement. These findings can be applied in future multidisciplinary-based decision-making processes for planning and executing orthognathic surgery.
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Affiliation(s)
- Hsin-Chih Lai
- Division of Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.-C.L.); (C.-T.H.)
| | - Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan;
| | - Cheng-Ting Ho
- Division of Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.-C.L.); (C.-T.H.)
| | - Hsiu-Hsia Lin
- Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan;
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Correlation Between Soft and Hard Tissue Changes in the Zygomaticomaxillary Region After Bone Contouring Surgery for Fibrous Dysplasia—A Preliminary Study. J Oral Maxillofac Surg 2019; 77:1904.e1-1904.e11. [DOI: 10.1016/j.joms.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 11/22/2022]
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13
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Three-dimensional analysis of nasolabial soft tissue changes after Le Fort I osteotomy: a systematic review of the literature. Int J Oral Maxillofac Surg 2019; 48:1185-1200. [DOI: 10.1016/j.ijom.2019.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 01/19/2019] [Accepted: 01/31/2019] [Indexed: 12/28/2022]
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14
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Schwaiger M, Echlin K, Atherton D, Haers P. The use of Medpor implants for midface contouring in cleft patients. Int J Oral Maxillofac Surg 2019; 48:1177-1184. [PMID: 30871847 DOI: 10.1016/j.ijom.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/22/2019] [Indexed: 01/17/2023]
Abstract
Three-dimensional midfacial deficiency in cleft patients is common and is frequently connected to impairment of the aesthetic facial appearance. Different approaches to augment relevant facial regions are available. Alloplastic facial implants have been established as a viable alternative to autologous tissue augmentation in various circumstances. However, in cleft patients, the application of facial implants has rarely been reported. This retrospective study aimed to evaluate the use of Medpor implants for midfacial contouring in cleft patients. Fifty-one patients with orofacial clefts were assessed with regard to defined parameters. A range of Paranasal, Malar and Nasal Dorsum Medpor implants had been used. Unilateral cleft lip and palate (UCLP) represented the most common indication, followed by bilateral cleft lip and palate (BCLP). Bilateral implant insertion was performed as a general rule with few exceptions. Insertion of implants was frequently combined with other cleft-related surgical procedures. Even after orthognathic surgery, midfacial augmentation was implemented to specifically address residual volume deficiency, particularly in the malar region. The complication rate amounted to 4.9% (6/122 implants). Based on our findings, Medpor implants are reliable and long-term stable materials to successfully augment paranasal, subnasal and malar areas as well as a solid nasal dorsum material with few complications in cleft patients.
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Affiliation(s)
- M Schwaiger
- South Thames Cleft Service, Guys and St. Thomas Hospital, London, UK.
| | - K Echlin
- South Thames Cleft Service, Guys and St. Thomas Hospital, London, UK
| | - D Atherton
- South Thames Cleft Service, Guys and St. Thomas Hospital, London, UK
| | - P Haers
- South Thames Cleft Service, Guys and St. Thomas Hospital, London, UK
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15
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Soft Tissue Changes in Patients Undergoing Intraoral Quadrangular Le Fort II Osteotomy Versus Conventional Le Fort I Osteotomy. J Oral Maxillofac Surg 2018; 76:416-425. [DOI: 10.1016/j.joms.2017.07.158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/12/2017] [Accepted: 07/11/2017] [Indexed: 11/21/2022]
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16
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Dornelles RDFV, Alonso N. New virtual tool for accurate evaluation of facial volume. Acta Cir Bras 2017; 32:1075-1086. [DOI: 10.1590/s0102-865020170120000009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/16/2017] [Indexed: 11/22/2022] Open
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17
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Three-Dimensional Analysis of Midfacial Soft Tissue Changes After Maxillary Posterior Impaction and Intraoral Vertical Ramus Osteotomy for Mandibular Setback in Class III Patients. J Craniofac Surg 2017; 28:1789-1796. [DOI: 10.1097/scs.0000000000003754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Resnick C, Dang R, Glick S, Padwa B. Accuracy of three-dimensional soft tissue prediction for Le Fort I osteotomy using Dolphin 3D software: a pilot study. Int J Oral Maxillofac Surg 2017; 46:289-295. [DOI: 10.1016/j.ijom.2016.10.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/29/2016] [Indexed: 11/29/2022]
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Almukhtar A, Ayoub A, Khambay B, McDonald J, Ju X. State-of-the-art three-dimensional analysis of soft tissue changes following Le Fort I maxillary advancement. Br J Oral Maxillofac Surg 2016; 54:812-7. [PMID: 27325452 DOI: 10.1016/j.bjoms.2016.05.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 05/20/2016] [Indexed: 11/29/2022]
Abstract
We describe the comprehensive 3-dimensional analysis of facial changes after Le Fort I osteotomy and introduce a new tool for anthropometric analysis of the face. We studied the cone-beam computed tomograms of 33 patients taken one month before and 6-12 months after Le Fort I maxillary advancement with or without posterior vertical impaction. Use of a generic facial mesh for dense correspondence analysis of changes in the soft tissue showed a mean (SD) anteroposterior advancement of the maxilla of 5.9 (1.7) mm, and mean (SD) minimal anterior and posterior vertical maxillary impaction of 0.1 (1.7) mm and 0.6 (1.45) mm, respectively. It also showed distinctive forward and marked lateral expansion around the upper lip and nose, and pronounced upward movement of the alar curvature and columella. The nose was widened and the nostrils advanced. There was minimal forward change at the base of the nose (subnasale and alar base) but a noticeable upward movement at the nasal tip. Changes at the cheeks were minimal. Analysis showed widening of the midface and upper lip which, to our knowledge, has not been reported before. The nostrils were compressed and widened, and the lower lip shortened. Changes at the chin and lower lip were secondary to the limited maxillary impaction.
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Affiliation(s)
- A Almukhtar
- Scottish Craniofacial Research Group, University of Glasgow, MVLS College, School of Medicine, Dental School, Glasgow, UK
| | - A Ayoub
- Scottish Craniofacial Research Group, University of Glasgow, MVLS College, School of Medicine, Dental School, Glasgow, UK.
| | - B Khambay
- Orthodontic Department, Dental School, University of Leeds, Leeds, UK
| | - J McDonald
- Honorary research fellow, Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - X Ju
- Medical Device Unit, Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Glasgow, UK
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Correlation Assessment between Three-Dimensional Facial Soft Tissue Scan and Lateral Cephalometric Radiography in Orthodontic Diagnosis. Int J Dent 2016; 2016:1473918. [PMID: 27313615 PMCID: PMC4903122 DOI: 10.1155/2016/1473918] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/12/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. The aim of the present prospective study was to investigate correlations between 3D facial soft tissue scan and lateral cephalometric radiography measurements. Materials and Methods. The study sample comprised 312 subjects of Caucasian ethnic origin. Exclusion criteria were all the craniofacial anomalies, noticeable asymmetries, and previous or current orthodontic treatment. A cephalometric analysis was developed employing 11 soft tissue landmarks and 14 sagittal and 14 vertical angular measurements corresponding to skeletal cephalometric variables. Cephalometric analyses on lateral cephalometric radiographies were performed for all subjects. The measurements were analysed in terms of their reliability and gender-age specific differences. Then, the soft tissue values were analysed for any correlations with lateral cephalometric radiography variables using Pearson correlation coefficient analysis. Results. Low, medium, and high correlations were found for sagittal and vertical measurements. Sagittal measurements seemed to be more reliable in providing a soft tissue diagnosis than vertical measurements. Conclusions. Sagittal parameters seemed to be more reliable in providing a soft tissue diagnosis similar to lateral cephalometric radiography. Vertical soft tissue measurements meanwhile showed a little less correlation with the corresponding cephalometric values perhaps due to the low reproducibility of cranial base and mandibular landmarks.
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Ullah R, Turner PJ, Khambay BS. Accuracy of three-dimensional soft tissue predictions in orthognathic surgery after Le Fort I advancement osteotomies. Br J Oral Maxillofac Surg 2016; 53:153-7. [PMID: 25432431 DOI: 10.1016/j.bjoms.2014.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 11/01/2014] [Indexed: 11/17/2022]
Abstract
Prediction of postoperative facial appearance after orthognathic surgery can be used for communication, managing patients' expectations,avoiding postoperative dissatisfaction and exploring different treatment options. We have assessed the accuracy of 3dMD Vultus in predicting the final 3-dimensional soft tissue facial morphology after Le Fort I advancement osteotomy. We retrospectively studied 13 patients who were treated with a Le Fort I advancement osteotomy alone. We used routine cone-beam computed tomographic (CT) images taken immediately before and a minimum of 6 months after operation, and 3dMD Vultus to virtually reposition the preoperative maxilla and mandible in their post operative positions to generate a prediction of what the soft tissue would look like. Segmented anatomical areas of the predicted mesh were then compared with the actual soft tissue. The means of the absolute distance between the 90th percentile of the mesh points for each region were calculated, and a one-sample Student's t test was used to calculate if the difference differed significantly from 3 mm.The differences in the mean absolute distances between the actual soft tissue and the prediction were significantly below 3 mm for all segmented anatomical areas (p < 0.001), and ranged from 0.65 mm (chin) to 1.17 mm (upper lip). 3dMD Vultus produces clinically satisfactory 3-dimensional facial soft tissue predictions after Le Fort I advancement osteotomy. The mass-spring model for prediction seems to be able to predict the position of the lip and chin, but its ability to predict nasal and paranasal areas could be improved.
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22
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Kim SJ, Baik HS, Hwang CJ, Yu HS. Diagnosis and evaluation of skeletal Class III patients with facial asymmetry for orthognathic surgery using three-dimensional computed tomography. Semin Orthod 2015. [DOI: 10.1053/j.sodo.2015.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Three-dimensional analysis of soft tissue changes in full-face view after surgical correction of skeletal class III malocclusion. J Craniofac Surg 2015; 24:725-30. [PMID: 23714867 DOI: 10.1097/scs.0b013e31828010a9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate changes in soft tissue in full-face view because of surgical correction of skeletal Class III malocclusion, using 3-dimensional (3D) laser scanning. METHODS Twenty-seven subjects with skeletal Class III malocclusion [11 males; mean age (SD), 24.0 (5.7) years] underwent bilateral sagittal split ramus osteotomy for mandibular setback combined with Lefort I osteotomy with/without maxillary advancement. Twelve patients (group 1) had mandibular setback surgery, and the other 15 (group 2) had combination surgery. Lateral cephalograms and 3D facial scan images were assessed preoperatively and postoperatively. The facial widths upon superimposition of 3D facial images were measured in the same coordinates using a Rapidform 2006 system. Paired and independent t tests were done for statistical analysis. RESULTS The midface soft tissue broadened significantly above the cheilion plane postoperatively (P < 0.05). A larger change was observed nearer to subnasale plane, and a similar trend was seen among the horizontal planes in 1- or 2-jaw surgery groups. The widths from the exocanthion plane to the subnasale plane increased more in group 2 [mean (SD), 4.45 (2.45) mm, 8.71 (2.92) mm, and 7.62 (3.13) mm] than those in group 1 [mean (SD), 1.26 (0.97) mm, 1.84 (1.06) mm, and 1.35 (0.65) mm], and this difference was significant (P < 0.05). There was a decrease below the cheilion plane with mandibular setback between groups, but this difference was not significant. CONCLUSIONS The measurement method used here for the shape outline of the lateral parts of the face could provide quantitative data for the clinical evaluation and objective analysis of the human face in full-face view. The midface soft tissue in subjects with skeletal Class III malocclusion exhibited a greater increase in width after bimaxillary surgery procedures than mandibular setback-only surgery.
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24
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Midfacial Volumetric and Upper Lip Soft Tissue Changes After Le Fort I Advancement of the Cleft Maxilla. J Oral Maxillofac Surg 2015; 73:708-18. [DOI: 10.1016/j.joms.2014.10.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/28/2014] [Accepted: 10/28/2014] [Indexed: 11/18/2022]
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25
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Current methods of assessing the accuracy of three-dimensional soft tissue facial predictions: technical and clinical considerations. Int J Oral Maxillofac Surg 2014; 44:132-8. [PMID: 25305699 DOI: 10.1016/j.ijom.2014.04.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/06/2014] [Accepted: 04/24/2014] [Indexed: 11/24/2022]
Abstract
Since the introduction of three-dimensional (3D) orthognathic planning software, studies have reported on their predictive ability. The aim of this study was to highlight the limitations of the current methods of analysis. The predicted 3D soft tissue image was compared to the postoperative soft tissue. For the full face, the maximum and 95th and 90th percentiles, the percentage of 3D mesh points ≤ 2 mm, and the root mean square (RMS) error, were calculated. For specific anatomical regions, the percentage of 3D mesh points ≤ 2 mm and the distance between the two meshes at 10 landmarks were determined. For the 95th and 90th percentiles, the maximum difference ranged from 7.7 mm to 2.2 mm and from 3.7 mm to 1.5 mm, respectively. The absolute mean distance ranged from 0.98 mm to 0.56 mm and from 0.91 mm to 0.50 mm, respectively. The percentage of mesh with ≤ 2 mm for the full face was 94.4-85.2% and 100-31.3% for anatomical regions. The RMS error ranged from 2.49 mm to 0.94 mm. The majority of mean linear distances between the surfaces were ≤ 0.8 mm, but increased for the mean absolute distance. At present the use of specific anatomical regions is more clinically meaningful than the full face. It is crucial to understand these and adopt a protocol for conducting such studies.
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26
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A systematic review on soft-to-hard tissue ratios in orthognathic surgery part I: Maxillary repositioning osteotomy. J Craniomaxillofac Surg 2014; 42:1341-51. [DOI: 10.1016/j.jcms.2014.03.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/16/2014] [Accepted: 03/20/2014] [Indexed: 11/23/2022] Open
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27
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Verdenik M, Ihan Hren N. Differences in three-dimensional soft tissue changes after upper, lower, or both jaw orthognathic surgery in skeletal class III patients. Int J Oral Maxillofac Surg 2014; 43:1345-51. [PMID: 25064429 DOI: 10.1016/j.ijom.2014.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/05/2014] [Accepted: 06/30/2014] [Indexed: 11/29/2022]
Abstract
The decision is not always straightforward as to which orthognathic procedure is best for a good aesthetic result; three-dimensional imaging has brought new insight into this topic. The aim of this prospective study was to verify objectively whether postoperative changes occur within those regions not directly affected by surgical movements of the underlying jaw bones. The study included 83 young adults with skeletal class III deformities. They were classified into three groups according to the type of surgery: bilateral sagittal split osteotomy set-back of the mandible (BSSO), Le Fort I advancement of the maxilla, or a combination of both. Pre- and postoperative optical scans were registered as regional best-fits on the areas of the foreheads and both orbits. The shell to shell differences were measured and the average distances between the observed regions were calculated. As expected, changes were greatest in the regions where the underlying bones had been moved, but regardless of the operation performed, changes were found over the whole face. Changes in the nose, cheek, and upper lip regions in the BSSO group and in the lower lip and chin region in the Le Fort I group confirmed the concept of the facial soft tissue mask acting as one unit.
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Affiliation(s)
- M Verdenik
- Clinical Department of Maxillofacial and Oral Surgery, University Clinical Centre Ljubljana, Slovenia.
| | - N Ihan Hren
- Clinical Department of Maxillofacial and Oral Surgery, University Clinical Centre Ljubljana, Slovenia
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28
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Three-dimensional soft tissue change after paranasal augmentation with porous polyethylene. Int J Oral Maxillofac Surg 2014; 43:816-23. [DOI: 10.1016/j.ijom.2014.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/05/2014] [Indexed: 11/17/2022]
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29
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Blockhaus M, Kochel J, Hartmann J, Stellzig-Eisenhauer A, Meyer-Marcotty P. Three-dimensional investigation of facial surface asymmetries in skeletal malocclusion patients before and after orthodontic treatment combined with orthognathic surgery. J Orofac Orthop 2014; 75:85-95. [DOI: 10.1007/s00056-013-0200-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 06/20/2013] [Indexed: 10/25/2022]
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Marşan G, Hocaoğlu E, Cura N, Emekli U. Nasal profile changes with le fort I maxillary advancement surgery. Cleft Palate Craniofac J 2013; 52:152-6. [PMID: 25714267 DOI: 10.1597/13-150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction : The purpose of this study was to quantify anteroposterior facial soft tissue changes with respect to underlying skeletal movements after Le Fort I maxillary advancement surgery by using lateral cephalograms taken before and after the operation. Materials and Methods : The study group consisted of 20 patients (10 women, 10 men; mean age 23.4 ± 1.4 years) having a Class III skeletal deformity caused by a retrognathic maxilla. All patients were treated by Le Fort I maxillary advancement osteotomy. Lateral cephalograms were taken before and 1.6 ± 0.4 years after surgery. Results : The anteroposterior position of A-point and anteroposterior position of maxillary incisor were significantly protracted (-2.69 ± 3.34 and -2.68 ± 3.21, respectively; P < .01). The nasal anteroposterior and superoinferior positions (NASALAP and NASALSI, respectively) were significantly changed (-2.70 ± 6.81, P < .01, and -2.55 ± 5.80, P < .05, respectively) and nasal elevation and protraction were observed after Le Fort I maxillary advancement surgery. Conclusions : The changes in anteroposterior and superoinferior positions of A-point were correlated with the nasal superoinferior position (r = -0.71 , P < .05; r = 0.72, P < .05) after Le Fort I maxillary advancement surgery.
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Choi JW, Lee JY, Oh TS, Kwon SM, Yang SJ, Koh KS. Frontal soft tissue analysis using a 3 dimensional camera following two-jaw rotational orthognathic surgery in skeletal class III patients. J Craniomaxillofac Surg 2013; 42:220-6. [PMID: 23870714 DOI: 10.1016/j.jcms.2013.05.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022] Open
Abstract
Although two dimensional cephalometry is the standard method for analyzing the results of orthognathic surgery, it has potential limits in frontal soft tissue analysis. We have utilized a 3 dimensional camera to examine changes in soft tissue landmarks in patients with skeletal class III dentofacial deformity who underwent two-jaw rotational setback surgery. We assessed 25 consecutive Asian patients (mean age, 22 years; range, 17-32 years) with skeletal class III dentofacial deformities who underwent two-jaw rotational surgery without maxillary advancement. Using a 3D camera, we analyzed changes in facial proportions, including vertical and horizontal dimensions, facial surface areas, nose profile, lip contour, and soft tissue cheek convexity, as well as landmarks related to facial symmetry. The average mandibular setback was 10.7 mm (range: 5-17 mm). The average SNA changed from 77.4° to 77.8°, the average SNB from 89.2° to 81.1°, and the average occlusal plane from 8.7° to 11.4°. The mid third vertical dimension changed from 58.8 mm to 57.8 mm (p = 0.059), and the lower third vertical dimension changed from 70.4 mm to 68.2 mm (p = 0.0006). The average bigonial width decreased from 113.5 mm to 109.2 mm (p = 0.0028), the alar width increased from 34.7 mm to 36.1 mm (p-value = 0.0002), and lip length was unchanged. Mean mid and lower facial surface areas decreased significantly, from 171.8 cm(2) to 166.2 cm(2) (p = 0.026) and from 71.23 cm(2) to 61.9 cm(2) (p < 0.0001), respectively. Cheek convexity increased significantly, from 171.8° to 155.9° (p = 0.0007). The 3D camera was effective in frontal soft tissue analysis for orthognathic surgery, and enabled quantitative analysis of changes in frontal soft tissue landmarks and facial proportions that were not possible with conventional 2D cephalometric analysis.
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Affiliation(s)
- Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, Ulsan University, College of Medicine, Seoul Asan Medical Center, 388-1 PungNap-2Dong, SongPa-Gu, Seoul 138-736, Republic of Korea.
| | | | - Tae-Suk Oh
- Department of Plastic and Reconstructive Surgery, Ulsan University, College of Medicine, Seoul Asan Medical Center, 388-1 PungNap-2Dong, SongPa-Gu, Seoul 138-736, Republic of Korea
| | | | - Sung Joon Yang
- Department of Plastic and Reconstructive Surgery, Ulsan University, College of Medicine, Seoul Asan Medical Center, 388-1 PungNap-2Dong, SongPa-Gu, Seoul 138-736, Republic of Korea
| | - Kyung Suk Koh
- Department of Plastic and Reconstructive Surgery, Ulsan University, College of Medicine, Seoul Asan Medical Center, 388-1 PungNap-2Dong, SongPa-Gu, Seoul 138-736, Republic of Korea
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Shafi MI, Ayoub A, Ju X, Khambay B. The accuracy of three-dimensional prediction planning for the surgical correction of facial deformities using Maxilim. Int J Oral Maxillofac Surg 2013; 42:801-6. [PMID: 23465803 DOI: 10.1016/j.ijom.2013.01.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 11/28/2012] [Accepted: 01/21/2013] [Indexed: 11/29/2022]
Abstract
The motivation for orthognathic surgery is to improve facial appearance and quality of life. This study aimed to validate a three-dimensional (3D) orthognathic planning programme (Maxilim) for predicting soft tissue changes following Le Fort I advancements. Cone beam computed tomography (CBCT) scans were taken before surgery (T(1)) and at 6-12 months after surgery (T(2)) for 13 patients. For each patient the 3D hard tissue changes between T(1) and T(2) were determined by CBCT superimposition on the cranial vault. Using Maxilim, each patient's skeletal movements were used to generate a 3D soft tissue prediction. The actual soft tissue mesh at T(2) was compared to the predicted mesh. The face was divided into areas: nose, right and left nares, right and left paranasal regions, upper and lower lip, and chin. The absolute distance between meshes for each region was calculated. A one-sample t-test showed the distances between the meshes for all of the areas were within 3 mm (P<0.05), except for the upper lip which was greater than 3 mm (P=0.577). Using Maxilim, 3D soft tissue predictions for Le Fort I advancements were clinically satisfactory in the regions assessed, but associated with marked errors around the region of the upper lip.
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Affiliation(s)
- M I Shafi
- Biotechnology and Craniofacial Sciences Research Group, Glasgow Dental School, University of Glasgow, Glasgow, UK
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Soft tissue stability after segmental distraction of the anterior mandibular alveolar process: a 5.5 year follow-up. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2012.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zou L, Adegun OK, Willis A, Fortune F. Facial biometrics of peri-oral changes in Crohn's disease. Lasers Med Sci 2013; 29:869-74. [PMID: 23435800 DOI: 10.1007/s10103-013-1286-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 02/08/2013] [Indexed: 02/02/2023]
Abstract
Crohn's disease is a chronic relapsing and remitting inflammatory condition which affects any part of the gastrointestinal tract. In the oro-facial region, patients can present peri-oral swellings which results in severe facial disfigurement. To date, assessing the degree of facial changes and evaluation of treatment outcomes relies on clinical observation and semi-quantitative methods. In this paper, we describe the development of a robust and reproducible measurement strategy using 3-D facial biometrics to objectively quantify the extent and progression of oro-facial Crohn's disease. Using facial laser scanning, 32 serial images from 13 Crohn's patients attending the Oral Medicine clinic were acquired during relapse, remission, and post-treatment phases. Utilising theories of coordinate metrology, the facial images were subjected to registration, regions of interest identification, and reproducible repositioning prior to obtaining volume measurements. To quantify the changes in tissue volume, scan images from consecutive appointments were compared to the baseline (first scan image). Reproducibility test was performed to ascertain the degree of uncertainty in volume measurements. 3-D facial biometric imaging is a reliable method to identify and quantify peri-oral swelling in Crohn's patients. Comparison of facial scan images at different phases of the disease revealed precisely profile and volume changes. The volume measurements were highly reproducible as adjudged from the 1% standard deviation. 3-D facial biometrics measurements in Crohn's patients with oro-facial involvement offers a quick, robust, economical and objective approach for guided therapeutic intervention and routine assessment of treatment efficacy on the clinic.
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Affiliation(s)
- L Zou
- Adult Oral Health, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
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Ueki K, Moroi A, Sotobori M, Ishihara Y, Marukawa K, Takatsuka S, Yoshizawa K, Kato K, Kawashiri S. A hypothesis on the desired postoperative position of the condyle in orthognathic surgery: a review. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:567-76. [DOI: 10.1016/j.oooo.2011.12.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 12/08/2011] [Indexed: 10/28/2022]
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Oh KM, Seo SK, Park JE, Sim HS, Cevidanes LHS, Kim YJR, Park YH. Post-operative soft tissue changes in patients with mandibular prognathism after bimaxillary surgery. J Craniomaxillofac Surg 2012; 41:204-11. [PMID: 23058178 DOI: 10.1016/j.jcms.2012.09.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 09/01/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate the three-dimensional soft tissue changes observed over time after bimaxillary surgery for mandibular prognathism using cone-beam computed tomography (CBCT) superimposed imaging. MATERIALS AND METHODS CBCT scans were obtained for 25 patients before bimaxillary surgery (T0), at 2 months after surgery (T1) and at 6 months after surgery (T2). Cephalometric variables from the reoriented volumetric images were measured and compared at T0, T1, and T2. The quantitative surface displacement in the middle and the lower third of the facial soft tissue using CMF tools was assessed by superimposing the T0 and T1 or T0 and T2 3D images. RESULTS The soft tissue in middle third of face moved forward at T1 and significantly moved backward from T1 to T2 (Ch-Al, p < 0.001; Al, p < 0.05; Pn, p < 0.05). Most of the soft tissue changes from T1 to T2 were not correlated with the hard tissue changes (p > 0.05), while the cheeks were positively correlated with the soft tissue around them (Exo-Al, p < 0.01; Ch-Al, p < 0.01). CONCLUSION Post-operative soft tissue changes occurred in the middle third of the face and are considered to be more complex than the changes in the lower third of face. Therefore, soft tissue assessment at least 6 months after surgery is desirable.
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Affiliation(s)
- Kyung-Min Oh
- Department of Orthodontics, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong 445, Gangdong-gu, Seoul 134-701, Republic of Korea
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Rustemeyer J, Martin A. Soft tissue response in orthognathic surgery patients treated by bimaxillary osteotomy: cephalometry compared with 2-D photogrammetry. Oral Maxillofac Surg 2012; 17:33-41. [PMID: 22562282 PMCID: PMC3576550 DOI: 10.1007/s10006-012-0330-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 04/21/2012] [Indexed: 11/29/2022]
Abstract
Purpose Since improvement of facial aesthetics after orthognathic surgery moves increasingly into the focus of patients, prediction of soft tissue response to hard tissue movement becomes essential for planning. The aim of this study was to assess the facial soft tissue response in skeletal class II and III patients undergoing orthognathic surgery and to compare the potentials of cephalometry and two-dimensional (2-D) photogrammetry for predicting soft tissue changes. Material and methods Twenty-eight patients with class II relationship and 33 with class III underwent bimaxillary surgery. All subjects had available both a traced lateral cephalogram and a traced lateral photogram taken pre- and postsurgery in natural head position (median follow-up, 9.4 ± 0.6 months). Results Facial convexity and lower lip length were highly correlated with hard tissue movements cephalometrically in class III patients and 2-D photogrammetrically in both classes. In comparison, cephalometric correlations for class II patients were weak. Correlations of hard and soft tissue movements between pre- and postoperative corresponding landmarks in horizontal and vertical planes were significant for cephalometry and 2-D photogrammetry. No significant difference was found between cephalometry and 2-D photogrammetry with respect to soft to hard tissue movement ratios. Conclusions This study revealed that cephalometry is still a feasible standard for evaluating and predicting outcomes in routine orthognathic surgery cases. Accuracy could be enhanced with 2-D photogrammetry, especially in class II patients.
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Affiliation(s)
- Jan Rustemeyer
- Department of Oral and Maxillofacial Surgery, Medical Centre Bremen-Mitte, School of Medicine, University of Göttingen, Bremen, Germany.
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Hwang DS, Kim YI, Park SB, Lee JY. Midfacial soft tissue changes after leveling Le Fort I osteotomy with differential reduction. Cone-beam computed tomography volume superimposition. Angle Orthod 2012; 82:424-431. [PMID: 21888537 PMCID: PMC8865816 DOI: 10.2319/052411-342.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 07/01/2011] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To compare the short- and long-side soft tissue changes in the midfacial areas of patients who have undergone superior repositioning Le Fort I osteotomies for the correction of occlusal cant. The null hypothesis was that there were no significant differences in the midfacial soft tissue changes between the greater- and lesser-reduction sides. MATERIALS AND METHODS The subjects included 25 patients who had undergone Le Fort I osteotomy with superior repositioning and mandibular setback sagittal split ramus osteotomy. Using the cone-beam computed tomography volume superimposition method, the soft tissue changes were measured and determined both preoperatively and postoperatively. A 10 × 27 grid at 4.5-mm (vertical) and 5-mm (horizontal) intervals was used for the hard to soft tissue response. RESULTS The mean difference in the reduction from leveling Le Fort I osteotomy was 3.2 ± 1.2 mm between the short and long sides (P < .05). The mandibular setback movement averaged 5.4 ± 3.3 mm on the long side and 5.0 ± 3.6 mm on the short side (P > .05). The soft tissue areas below the Frankfort horizontal (FH) plane to 13.5 mm showed different changes after the differential leveling Le Fort I osteotomies. CONCLUSIONS The distinctly changed areas, which showed differences between the greater- and lesser-reduction sides beyond the 2.5-mm average for the soft tissue response, were below the FH plane to 13.5 mm and lateral to the midsagittal reference plane to 30 mm. In light of this, oral surgeons and orthodontists should be concerned about the volumetric midfacial difference after leveling the maxillary occlusal plane at the preoperative stage and thus should take appropriate measures to improve it.
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Affiliation(s)
- Dae-Seok Hwang
- Assistant, Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University Hospital, Pusan, South Korea
| | - Yong-Il Kim
- Clinical Assistant Professor, Department of Orthodontics, School of Dentistry, Pusan National University Hospital, Pusan, South Korea
| | - Soo-Byung Park
- Professor, Department of Orthodontics, School of Dentistry, Pusan National University Hospital, Pusan, South Korea
| | - Jae-Yeol Lee
- Clinical Assistant Professor, Department of Oral and Maxillofacial surgery, School of Dentistry, Pusan National University Hospital, Pusan, South Korea
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Reaction of facial soft tissues to treatment with a Herbst appliance. J Orofac Orthop 2012; 73:116-25. [DOI: 10.1007/s00056-011-0068-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 12/01/2011] [Indexed: 10/28/2022]
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Joss CU, Triaca A, Antonini M, Kiliaridis S, Kuijpers-Jagtman AM. Soft tissue stability in segmental distraction of the anterior mandibular alveolar process. A 2-year follow-up. Int J Oral Maxillofac Surg 2011; 41:560-5. [PMID: 22204924 DOI: 10.1016/j.ijom.2011.07.1070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 04/12/2011] [Accepted: 07/20/2011] [Indexed: 11/18/2022]
Abstract
This study evaluated soft tissue changes in adult patients treated with distraction osteogenesis (DOG) of the anterior mandibular alveolar process and related it to different parameters. 33 patients (27 females; 6 males) were analysed retrospectively before surgery at T1 (17.0 days), after surgery at T2 (mean 6.5 days), at T3 (mean 24.4 days), and at T4 (mean 2.0 years). Lateral cephalograms were traced by hand, digitized, superimposed, and evaluated. Statistical analysis was carried out using Kolmogorov-Smirnov test, paired t test, Pearson's correlation coefficient, and linear backward regression analysis. 2 years postoperatively (T4), the net effect of the soft tissue at point B' was 100% of the advancement at point B whilst the lower lip (labrale inferior) followed the advancement of incision inferior to 46%. Increased preoperative age was correlated (p<0.05) with more horizontal backward movement (T4-T3) for labrale superior and pogonion'. Higher NL/ML' angles were significantly correlated (p<0.05) with smaller horizontal soft tissue change at point B'. Gender and the amount of skeletal and dental advancement were not correlated with postoperative soft tissue changes (T4-T3). DOG of the anterior mandibular alveolar process is a valuable alternative for mandibular advancement regarding soft tissue change and predictability.
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Affiliation(s)
- C U Joss
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Early Orthognathic Surgery With Three-Dimensional Image Simulation During Presurgical Orthodontics in Adults. J Craniofac Surg 2011; 22:473-81. [DOI: 10.1097/scs.0b013e318207b95c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Validation of Optical Three-Dimensional Plagiocephalometry by Computed Tomography, Direct Measurement, and Indirect Measurements Using Thermoplastic Bands. J Craniofac Surg 2011; 22:129-34. [PMID: 21187761 DOI: 10.1097/scs.0b013e3181f6f849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Three-Dimensional Facial Asymmetry in Attractive and Normal People from Childhood to Young Adulthood. Symmetry (Basel) 2010. [DOI: 10.3390/sym2041925] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Soft Tissue Profile Changes After Bilateral Sagittal Split Osteotomy for Mandibular Setback: A Systematic Review. J Oral Maxillofac Surg 2010; 68:2792-801. [DOI: 10.1016/j.joms.2010.04.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 04/25/2010] [Indexed: 11/24/2022]
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Development of a simulation system in mandibular orthognathic surgery based on integrated three-dimensional data. Oral Maxillofac Surg 2010; 15:131-8. [PMID: 20981462 PMCID: PMC3157604 DOI: 10.1007/s10006-010-0247-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Accepted: 10/11/2010] [Indexed: 11/24/2022]
Abstract
Purpose Surgical simulation should reflect the 3D movement of dentition and the resultant movement of the osteotomized segments, which can influence surgical outcome. The present study was aimed at developing a new simulation system that enables virtual osteotomy of a given surgical situation and evaluation of the bony interference between the osteotomized segments of the mandible. Subjects and methods The data of 3D computer tomography (CT) for maxillomandibular dental casts were integrated into the standard coordinates of a 3D cephalogram. To evaluate the accuracy of the system, measurement errors of the 3D CT virtual model from a dry skull were compared with the computer simulation system and a contact-type 3D digitizer. To examine the clinical accessibility, 15 mandibular prognathism patients with mild to severe asymmetry were evaluated with the simulation program. Results The average error of measurement in all directions was 1.31 mm. It was possible to simulate various osteotomy procedures by conversion of the 3D coordinates of the dental cast and CT data into the standard coordinate system of a 3D cephalogram. Using this simulation system, it was possible to prevent condylar torque or segment malpositioning by removing the bony interference visualized by a 3D virtual model. Conclusion A new system, which enables the precise visualization of osteotomized segments and calculation of bony interference, was proposed in the present study. This new system provides an acceptable precision of treatment planning of orthognathic surgery, especially for facial asymmetry.
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Three-Dimensional Analysis of Midfacial Soft Tissue Changes According to Maxillary Superior Movement After Horizontal Osteotomy of the Maxilla. J Craniofac Surg 2010; 21:1587-90. [DOI: 10.1097/scs.0b013e3181edc5c9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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47
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Joss CU, Joss-Vassalli IM, Kiliaridis S, Kuijpers-Jagtman AM. Soft Tissue Profile Changes After Bilateral Sagittal Split Osteotomy for Mandibular Advancement: A Systematic Review. J Oral Maxillofac Surg 2010; 68:1260-9. [DOI: 10.1016/j.joms.2010.01.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 09/23/2009] [Accepted: 01/04/2010] [Indexed: 11/28/2022]
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Kochel J, Meyer-Marcotty P, Kochel M, Schneck S, Stellzig-Eisenhauer A. 3D soft tissue analysis--part 2: vertical parameters. J Orofac Orthop 2010; 71:207-20. [PMID: 20503003 DOI: 10.1007/s00056-010-9943-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 02/11/2010] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The increasing relevance of 3D methods in orthodontic diagnostics and treatment planning calls for the development of new analysis methods and the definition of three-dimensional mean values. OBJECTIVE The aim of this study was to develop a reliable three-dimensional (3D) analysis of facial soft tissues. Our objectives were to determine vertical 3D mean values and define the relationship between vertical skeletal parameters and digitally-recorded 3D soft tissue parameters. PATIENTS AND METHODS A total of 100 adult patients (female symbol = 53, male symbol = 47) of Caucasian ethnic origin were included in the study. Patients with syndromes, cleft lip and palate, noticeable asymmetry or anomalies in the number of teeth were excluded. Arithmetic means for three vertical 3D soft tissue parameters were calculated. The parameters were analyzed biometrically in terms of their reliability and gender-specific differences. Furthermore, the 3D soft tissue values were analyzed with regard to any correlations with vertical cephalometric values. In addition, we employed stepwise discriminant analysis, a multivariate statistical method, to examine the extent to which correct assessment of craniofacial morphology is possible by referring to those 3D parameters. RESULTS We successfully defined reproducible 3D mean values for the 3D soft tissue parameters, demonstrating highly significant correlations between the vertical 3D soft tissue measurements and cephalometric measurements. 89.8% of the patients could be correctly assigned to a vertical or horizontal craniofacial morphology according to the 3D soft tissue values. CONCLUSION 3D soft tissue analysis provides information about vertical skeletal parameters, allowing assessment of vertical craniofacial morphology. Further investigation will be required so that 3D soft tissue diagnosis can be integrated into treatment planning and assessment as a supportive diagnostic tool in the future.
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Affiliation(s)
- Janka Kochel
- Department of Orthodontics, University of Wuerzburg, Pleicherwall 2, Wuerzburg, Germany.
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Soft tissue assessment in midface advancement: the use of regional flaps to enhance facial projection. J Craniofac Surg 2010; 20 Suppl 2:1809-11. [PMID: 19816355 DOI: 10.1097/scs.0b013e3181b6c187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Classically, soft tissue repair when indicated is done before or after the skeletal mobilization especially in those cases that present midface deficiency with severe midline soft tissue restriction by scars or congenital affectation. The distraction osteogenesis method has contributed to improve substantially this problem elongating bones, muscles, and ligaments, but some situations need specific and more precise reconstruction of the subunits to gain in aesthetics. The labial-columella junction, the tip of the nose, and the more projecting point of the cheeks are one of these exigent anatomic areas, where only sophisticated reconstruction by flaps can improve facial proportions and projections.
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Kochel J, Meyer-Marcotty P, Strnad F, Kochel M, Stellzig-Eisenhauer A. 3D soft tissue analysis--part 1: sagittal parameters. J Orofac Orthop 2010; 71:40-52. [PMID: 20135249 DOI: 10.1007/s00056-010-9926-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 11/20/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to develop a reliable three-dimensional (3D) analysis of facial soft tissues. We determined the mean sagittal 3D values and relationships between sagittal skeletal parameters, and digitally recorded 3D soft tissue parameters. PATIENTS AND METHODS A total of 100 adult patients (n(female) = 53, n(male) = 47) of Caucasian ethnic origin were included in this study. Patients with syndromes, cleft lip and palate, noticeable asymmetry or anomalies in the number of teeth were excluded. Arithmetic means for seven sagittal 3D soft tissue parameters were calculated. The parameters were analyzed biometrically in terms of their reliability and gender-specific differences. The 3D soft tissue values were further analyzed for any correlations with sagittal cephalometric values. RESULTS Reproducible 3D mean values were defined for 3D soft tissue parameters. We detected gender-specific differences among the parameters. Correlations between the sagittal 3D soft tissue and cephalometric measurements were statistically significant. CONCLUSION 3D soft tissue analysis provides additional information on the sagittal position of the jaw bases and on intermaxillary sagittal relations. Further studies are needed to integrate 3D soft tissue analysis in future treatment planning and assessment as a supportive diagnostic tool.
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Affiliation(s)
- Janka Kochel
- Department of Orthodontics, University of Wuerzburg, Wuerzburg, Germany.
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